Yesterday’s blog began a series of discussions about “The Evolution of Our Understanding of Concussion, otherwise Called Mild Traumatic Brain Injury.” Today I continue to follow the topics of my YouTube videos on this theme. Today’s video is found here: http://www.youtube.com/profile?user=braininjuryattorney#p/u/10/_kgiKz6WGSw
Today’s subset of this theme deals with the role that the various concussion and sport guidelines played in changing how the medical community and the public looked at concussion. The first set of those guidelines came out of an article written by James Kelly, M.D. in JAMA, the Journal of the American Medical Association: J.P. Kelly et al., Concussion in Sports, Guidelines for the Prevention of Catastrophic Outcome, 266 JAMA 2867, 2868 (1991). Kelly’s article was also really the first to warn of the danger of the “second impact syndrome”. It is concern about the second impact syndrome, where the second concussion leads to a catastrophic increase in intracranial pressure, that fueled much of the early development of these guidelines.
Among the important contributions of that first work on concussion and sport were the no-return to play if a concussion was symptomatic for more than 15 minutes and the requirement that a concussion that was symptomatic for more than 15 minutes would require serial evaluations until the symptoms had cleared. That first guideline, promulgated by the American Academy of Neurology required that symptoms would have to clear for a full seven days before the athlete was allowed to return to play.
The reason this serial evaluation requirement is so significant is that it is not the symptoms that an individual has on the day of that determines the severity of concussion, but how symptomatic they are at 24 hours, 48 hours, 72 hours.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
http://subtlebraininjury.com
http://car-accident-rain.com
http://tbilaw.com
http://waiting.com
http://vestibulardisorder.com
http://youtube.com/profile?user=braininjuryattorney
g@gordonjohnson.com
800-992-9447
The Evolution of Our Understanding of Concussion, otherwise Called Mild Traumatic Brain Injury
I have been blogging over the holidays about concussions because once again they have been in the news. As discussed on this blog, Texas Tech coach Mike Leach was fired because of his forced isolation of wide receiver Adam James after he was diagnosed with a concussion. See also my comment on a related issue on one of my Brain Injury Lawyer Blog: http://www.waiting.com/blog/
With these stories bringing concussion back in the headlines, it seems appropriate to spend the next several blogs discussing the evolution of how our medical community has viewed concussion. Prior to about 1990, there was almost universal ignorance in the medical community about concussion. Most textbooks and learned treatises which neurologists, emergency room doctors and medical students relied on, simply had it wrong. Among the most significant mistakes was the belief that an individual had to be unconscious to have suffered a brain injury. That significantly began to change with the publication of a definition of mild traumatic brain injury in 1992 by the American Congress of Rehabilitation Medicine. (Definition of Mild Traumatic Brain Injury, Developed by the Mild Traumatic Brain Injury Committee of the Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine. J Head Trauma Rehabil 1993:8(3):86-87)
That definition is found at http://tbilaw.com/RehabDefinitionPage.php
To understand where we need to go with continuing improvement in the diagnosis of brain injury, I think it is important that we understand where we have come from. Thus, I created a series of lectures on this topic, found on my YouTube page http://www.youtube.com/profile?user=braininjuryattorney#p/u. The first of those lectures can be found at:
http://www.youtube.com/profile?user=braininjuryattorney#p/u/13/x2EKaVHpVd0
In this series of blogs, I will discuss the topics of each of those videos.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
http://subtlebraininjury.com
http://car-accident-rain.com
http://tbilaw.com
http://waiting.com
http://vestibulardisorder.com
http://youtube.com/profile?user=braininjuryattorney
g@gordonjohnson.com
800-992-9447
With these stories bringing concussion back in the headlines, it seems appropriate to spend the next several blogs discussing the evolution of how our medical community has viewed concussion. Prior to about 1990, there was almost universal ignorance in the medical community about concussion. Most textbooks and learned treatises which neurologists, emergency room doctors and medical students relied on, simply had it wrong. Among the most significant mistakes was the belief that an individual had to be unconscious to have suffered a brain injury. That significantly began to change with the publication of a definition of mild traumatic brain injury in 1992 by the American Congress of Rehabilitation Medicine. (Definition of Mild Traumatic Brain Injury, Developed by the Mild Traumatic Brain Injury Committee of the Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine. J Head Trauma Rehabil 1993:8(3):86-87)
That definition is found at http://tbilaw.com/RehabDefinitionPage.php
To understand where we need to go with continuing improvement in the diagnosis of brain injury, I think it is important that we understand where we have come from. Thus, I created a series of lectures on this topic, found on my YouTube page http://www.youtube.com/profile?user=braininjuryattorney#p/u. The first of those lectures can be found at:
http://www.youtube.com/profile?user=braininjuryattorney#p/u/13/x2EKaVHpVd0
In this series of blogs, I will discuss the topics of each of those videos.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
http://subtlebraininjury.com
http://car-accident-rain.com
http://tbilaw.com
http://waiting.com
http://vestibulardisorder.com
http://youtube.com/profile?user=braininjuryattorney
g@gordonjohnson.com
800-992-9447
Texas Tech Isolation for Concussed Athlete Scandal Gets Worse
After listening to a day’s coverage of the Texas Tech coach Mike Leach scandal over isolating of wide receiver Adam James after he was diagnosed with a concussion, I am shocked at how similar Leach’s defense tactics are to those we see if almost every case. It only took about 24 hours for the Leach’s legal team to start attacking James’s character. They want to shift the focus from the outrageous conduct of the accused to the poor qualities James has as a person.
Yesterday, the claim started that they were isolating James to keep him cool. I checked the weather in Lubbock, Texas on December 17, 2009, the day he was put in the equipment shed, forced to stand in the dark. High temperature for the day, 64.9 °F at 3:53 PM. I am sure they did it to protect him from heat exhaustion. Not. See http://www.wunderground.com/history/airport/KLBB/2009/12/17/DailyHistory.html?req_city=NA&req;_state=NA&req;_statename=NA
By last night Leach’s defense attorney had gone of the offensive. Now the attacks were that problems with James had started in the day’s before what they now called a “claimed” concussion. The problems with James were really about his poor effort in practice (before the concussion) and complaints about his lack of playing time.
This mirrors the exact tactics defense attorney’s use in almost every mild brain injury case. A corporate wrongdoer can run into someone with a semi, but by the time it gets to a courtroom, the case gets spun that the plaintiff is unworthy and was just looking for an excuse to take the rest of his or her life off.
In the days after a concussion, the brain is trying mightily to rewire itself to deal with the new challenges. That rewiring is not always positive. Add panic or emotional distress and the plasticity that we all hope will avoid negative consequences, can rewire the brain in the wrong ways. I call this “negative plasticity” and I believe it is one of the strongest arguments for better and more thorough diagnosis and follow-up for concussion.
You do not isolate, with guards, regardless of what training the guards have, someone whose brain is particularly vulnerable at that moment. This is almost as dangerous as moving someone with a neck injury. Dark, isolated places, are not a good idea. Emotions are very vulnerable at such time and adding an element of panic to the equation is virtually guaranteed to create more problems.
Yesterday I was willing to let Leach off with a bit of homework on concussion. See http://blog.subtlebraininjury.com/2009/12/texas-tech-coach-suspended-for-charges.html Today after hearing more details and the misdirection and spin of his defenders, I think the man should be fired. Concussions are to be taken seriously and anyone who wants to abuse a concussion survivor by attacking such person’s character needs to pay the consequences. Leach needs to be made an example of.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
http://subtlebraininjury.com
http://car-accident-rain.com
http://tbilaw.com
http://waiting.com
http://vestibulardisorder.com
http://youtube.com/profile?user=braininjuryattorney
g@gordonjohnson.com
800-992-9447
Yesterday, the claim started that they were isolating James to keep him cool. I checked the weather in Lubbock, Texas on December 17, 2009, the day he was put in the equipment shed, forced to stand in the dark. High temperature for the day, 64.9 °F at 3:53 PM. I am sure they did it to protect him from heat exhaustion. Not. See http://www.wunderground.com/history/airport/KLBB/2009/12/17/DailyHistory.html?req_city=NA&req;_state=NA&req;_statename=NA
By last night Leach’s defense attorney had gone of the offensive. Now the attacks were that problems with James had started in the day’s before what they now called a “claimed” concussion. The problems with James were really about his poor effort in practice (before the concussion) and complaints about his lack of playing time.
This mirrors the exact tactics defense attorney’s use in almost every mild brain injury case. A corporate wrongdoer can run into someone with a semi, but by the time it gets to a courtroom, the case gets spun that the plaintiff is unworthy and was just looking for an excuse to take the rest of his or her life off.
In the days after a concussion, the brain is trying mightily to rewire itself to deal with the new challenges. That rewiring is not always positive. Add panic or emotional distress and the plasticity that we all hope will avoid negative consequences, can rewire the brain in the wrong ways. I call this “negative plasticity” and I believe it is one of the strongest arguments for better and more thorough diagnosis and follow-up for concussion.
You do not isolate, with guards, regardless of what training the guards have, someone whose brain is particularly vulnerable at that moment. This is almost as dangerous as moving someone with a neck injury. Dark, isolated places, are not a good idea. Emotions are very vulnerable at such time and adding an element of panic to the equation is virtually guaranteed to create more problems.
Yesterday I was willing to let Leach off with a bit of homework on concussion. See http://blog.subtlebraininjury.com/2009/12/texas-tech-coach-suspended-for-charges.html Today after hearing more details and the misdirection and spin of his defenders, I think the man should be fired. Concussions are to be taken seriously and anyone who wants to abuse a concussion survivor by attacking such person’s character needs to pay the consequences. Leach needs to be made an example of.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
http://subtlebraininjury.com
http://car-accident-rain.com
http://tbilaw.com
http://waiting.com
http://vestibulardisorder.com
http://youtube.com/profile?user=braininjuryattorney
g@gordonjohnson.com
800-992-9447